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Methods to reduce opioid use during surgical treatment of pediatric supracondylar fractures - a pilot study.

Authors
  • Kim, Kelvin1
  • Armstrong, Douglas2
  • Hennrikus, William3
  • 1 Univerity of Las Vegas, Nevada, Department of Orthopedic Surgery, 2040 W Charleston Blvd. Las Vegas, NV 89102, United States. , (United States)
  • 2 Penn State Hershey Medical Center, 30 Hope Drive, Building A, Hershey, PA 17033, United States. , (United States)
  • 3 Penn State Hershey Medical Center, 30 Hope Drive, Building A, Hershey, PA 17033, United States. Electronic address: [email protected] , (United States)
Type
Published Article
Journal
Injury
Publication Date
Jun 01, 2021
Volume
52
Issue
6
Pages
1331–1335
Identifiers
DOI: 10.1016/j.injury.2020.10.092
PMID: 33213865
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The current opioid epidemic is a national problem and an increasing concern for pediatric orthopedic patients. The utilization of non-opioid pain methods may help improve the over-prescribing and overuse of opioid medications. The present study is a pain medication usage study that aims to investigate the effects of an intraoperative bupivacaine (BP) fracture injection and IV paracetamol on postoperative opioid consumption when treating supracondylar fractures of the humerus in children. The study was approved by the college of medicine's institutional review board (IRB). Forty-two patients treated for a type-III supracondylar extension-type fracture of the humerus by 2 surgeons were reviewed. Two cohorts (n = 21) were compared based on whether patients received an intraoperative fracture injection of BP. A sub-analysis was performed among the BP cohort by stratifying patients who received only BP and patients who received BP and intraoperative IV paracetamol. Data variables evaluated included baseline patient characteristics and postoperative inpatient analgesic use. The BP cohort received a lesser number of opioid doses during the total postoperative hospital stay (2.1 ± 1.8 versus 3.6 ± 2.5; p = 0.031) as well as average morphine-milligram equivalents (MME) (11.8 ± 15.9 versus 4.2 ± 5.2; p = 0.044). When the BP cohort was stratified by patients who did and did not receive intraoperative IV paracetamol, during their total postoperative hospital stay, the paracetamolgroup consumed analgesic medication less frequently (p = 0.005), consumed less opioid doses (p = 0.011), and consumed less morphine-milligram-equivalents of opioids (p = 0.043). Opioid abuse and overuse in children is part of a national healthcare crisis. The use of BP injected into the fracture at the time of surgery is safe, effective, and reduces the need for opioids. Furthermore, the combination of intraoperative BP and IV paracetamol demonstrated less utilization of opioids than BP alone. Copyright © 2020. Published by Elsevier Ltd.

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